What is a Colon and Rectal Surgery Specialist and what is the difference between a Colon and Rectal Surgeon and a Gastroenterologist?

Colon and Rectal Surgeons are experts in the surgical and medical management of diseases of the Colon, Rectum and Anus.  They have completed five years of training in General Surgery, followed by additional advanced training in the field of Colon and Rectal Surgery.  Board Certification means that those surgeons have completed accredited training programs and have passed extensive examinations conducted by the American Board of Surgery and the American Board of Colon and Rectal Surgery. 

Gastroenterologists are Internal Medicine physicians who have taken additional training in the Medical management of Gastrointestinal disorders.   They also take certification examinations to assess and document their proficiency.

The two specialties often overlap and may work together to care for the same disease process.  Both specialties perform upper and lower Endoscopies, for example.

Why do I need a Colonoscopy?

The major reason for screening is prevention of Colon Cancer.   The goal is to find colon polyps before they develop into colon cancer.  About 25% of patients will have a colon polyp the first time they are screened.   Additionally, the goal is to find colon cancer, if present, in as early a stage as possible, while it is curable.  This could be Life Saving!

When should I undergo a colonoscopy?

A Screening Colonoscopy should be done at age 50, or at age 45 for African Americans. 

A Diagnostic Colonoscopy may be done at any age.  This may be recommended by your Doctor if you are having symptoms or signs involving the GI Tract.

How often is Colonoscopy Recommended?

Colonoscopy is recommended every ten years if your exam was normal, and if you don’t have any risk factors for Colorectal Cancer.  Patients who are at increased risk, have a history of polyps, or have a family history of Colorectal Cancer, may require colonoscopy more frequently.

Will Insurance Cover the Cost of the Colonoscopy?

Most Insurance Companies cover Colonoscopic Screening.  You should check with your Insurance Company to be certain of your benefits.  The final portion of the cost to you may vary depending on your deductible, where you have it done, and whether biopsies or polyp removal is done.

How do I prepare for Colonoscopy?

For a colonoscopy to be accurate, the colon needs to be cleaned out of all stool and solid matter.  You will go on a clear liquid diet the day before the exam and take a laxative preparation.  This will be discussed in detail with you at your office appointment.  Your medications will be reviewed with you and any adjustments made as to whether and when you should take them.  Following the instructions fully is critical to the success of your colonoscopy.  If the colon is not adequately cleaned out, then your physician will not be able to see well enough to complete your procedure. 

Contact the Physician’s office if you have questions about the prep, how to take your medications, or if you experience problems during or after the prep.

How Long Do I Need to Allow for the Test?

We advise our patients to plan to spend from 2-3 hours at the Endoscopy Center.

You will be instructed to arrive for the colonoscopy about 30 min to one hour before the procedure.  During this time, you will sign paperwork, change into a hospital gown, have an IV started, meet the Anesthesia personnel, and have your medical history reviewed. 
The colonoscopy usually takes 15-30 minutes.

After the colonoscopy is completed, you will go to the Recovery Room for about 30 minutes, until you are awake and tolerating liquids.  Your physician will speak to you about the findings while you are in the Recovery Room.

Is Colonoscopy painful during the procedure or afterwards?

The colonoscopy should not be painful since you will be sedated.   Most people wake up in the recovery room asking “when is the procedure going to start?” The colon is like a collapsed balloon when it has been cleaned out.  Your physician instills air into the colon, inflating it which allows for a complete view of all walls.   Your physician tries to remove as much air as possible as the scope is withdrawn, but it is impossible to remove all of it.   This may cause a feeling of bloating or cramping during or after the procedure for several hours.  The best way to get over this discomfort is to eat lightly and walk until you have passed the air.

You should call your physician promptly if you experience severe abdominal pain, fever or GI bleeding.

What Type of Anesthesia is used for colonoscopy?

Conscious sedation is a type of moderate IV sedation, administered by the Endoscopy Nurse or Nurse Anesthetist to keep you comfortable during the procedure.  You will be breathing on your own, not on a ventilator.  To be sure you are safe, you will be continuously monitored with EKG, oxygen saturation, and BP monitoring.  The medication has a quick onset of action and quick recovery once administration of the drug has ceased.

What will the Physician do if abnormalities are found during Colonoscopy?

Photographs will be taken of any finding that is abnormal.  These will be reviewed with you at the completion of your procedure.   If polyps are found, the goal is to remove them.  This can be done by use of tools that are inserted through the side channel of the colonoscope, allowing for pinch biopsy or snare (wire lasso) removal in the majority of cases.  If a polyp is too large, in a difficult location, or if there is concern that the polyp may contain cancer, then a biopsy or sample of the tissue will be obtained and sent to the lab for diagnosis. The lining of the colon or mucosa may also be biopsied if there is evidence of ulceration, bleeding or other abnormalities.  These findings will be discussed with you in recovery and a plan made for further treatment if needed.

Will my privacy be maintained during the procedure?

Yes.  Maintaining your privacy is of utmost importance.  Your physician, the Nurse monitoring your Vital signs, the Nurse Anesthetist providing your sedation, and the Endoscopy Technician will be the only personnel in the room.

Will I talk inappropriately, tell secrets or embarrass myself while under sedation?

No. You will be sedated and sleeping during the procedure.  You will not be able to watch or ask questions during the procedure.

May I drive myself home or work the day of the colonoscopy?

No.  Since you have been sedated, you may be groggy and sleepy for the rest of the day.  Your judgement may be altered.  Therefore we do not think it is safe for you to drive, operate machinery, cook, care for children or the elderly, or perform any activities that require judgement.

We recommend taking it easy for the rest of the day after you arrive home, eating a light diet, drinking plenty of fluids and rest.  You may return to your regular activities the following morning.

Are there alternatives to Colonoscopy?

Colonoscopy is considered the best test available for colon screening.  It is the only test that allows for removal of polyps or biopsy of abnormal tissue.  Other benefits are that Colonoscopy can detect small and flat polyps that may be missed by other screening methods.  Also you are sedated for the procedure so that you are comfortable throughout, and don’t have to have it done but every 10 years unless there is an abnormal finding.

Other screening methods approved by the American Cancer Society include one of the following:  annual test of stool for blood, Flexible Sigmoidoscopy which looks at the last third of your colon, Barium Enema or CT Colonography.  They are recommended to be done every 5 years since they are not as accurate as Colonoscopy.  Each of these tests has some advantages and limitations that affect the quality of your screening.  Since none of these tests are able to remove polyps or obtain tissue for diagnosis, a colonoscopy will be required anyway if any abnormalities are found.

May I drink Alcoholic Beverages during my prep such as beer, wine or a cocktail?

We do not recommend consuming any alcoholic beverages during your prep.  Technically they are clear liquids, but alcohol is very dehydrating and may alter your judgment during the prep. 

May I use Artificial Sweeteners in my prep clear liquids?


Will I be able to have my Colonoscopy done during my Menstrual Cycle?

Yes.  There is no contraindication to proceeding with Colonoscopy during your menstrual cycle.  You may use a tampon or menstrual pad to control your menstrual flow, whichever is your preference.

Who Needs antibiotics before a Colonoscopy?

Few patients need antibiotics before colonoscopy.  The risk of bacteria entering the blood stream during the procedure is very low, much lower even than with dental work.  For years we have given IV or oral antibiotics before some colonoscopies, but guidelines have changed.  The American Heart Association in 4/2007 updated its guidelines.  The new guideline states that “the administration of prophylactic antibiotics solely to prevent endocarditis is not recommended for patients undergoing Urologic or Gastrointestinal procedures, including Upper Endoscopy (EGD) and colonoscopy.

My Orthopedist says I need antibiotics before my colonoscopy because I’ve had a total joint replacement? Is this true?

No.  The American Society of Gastrointestinal Endoscopy (ASGE) has concluded that antibiotic prophylaxis is not recommended for patients with prosthetic joints.  Infection of prosthetic joints related to endoscopy is extremely rare. Some physicians will administer antibiotics if the patient is undergoing polyp removal within six months of a prosthesis insertion. 

The evidence to support the use of antibiotics in these situations is controversial and the risk of infection in these conditions is low.  Your physician will discuss these concerns with you.

What are the risks of Colonoscopy?

The two major risks of colonoscopy are bleeding and colon perforation.  Both are rare events occurring less than 1% of the time.
Bleeding can occur from any biopsy site.  Patients are advised to avoid drugs such as aspirin, anti-inflammatories, and anticoagulants that increase the risk for bleeding in the post procedure period.  Bleeding would present as passage of blood into the commode.  If excessive bleeding occurs post procedure, you should call your Doctor Immediately. 

Perforation can occur also at a biopsy site or from a tear or puncture of the colon from the colonoscope.  A minor perforation is usually treated with antibiotics and GI Tract rest.  A major perforation with severe abdominal pain, or fever will require an urgent operation.  If you have severe abdominal pain or fever after your procedure, you should call your Doctor immediately.

I have seen blood in the commode and in my Bowel Movements. Is this normal?

No.  Rectal bleeding is NEVER normal.  This warrants investigation by your physician.  The exact testing required will vary from patient to patient, but may include simple dietary changes, medications, office procedures, colonoscopy or even surgery.  Once the cause of the bleeding has been identified, a plan of treatment will be offered.

I have pain during and after a Bowel Movement. How can this be treated?

Pain during and after a Bowel movement is not normal and should be evaluated by your physician.  Many different diseases may cause pain with defecation. 

Which month is designated as Colon and Rectal Cancer Awareness Month?

March.  Colon and Rectal Cancer is the third most common cancer in the United States, affecting men and women and all races equally.  Colon and Rectal Cancer can be prevented by having routine colon screenings and a healthy lifestyle.  We know that the majority of Colon and Rectal Cancers start from polyps.  If we remove the polyps, we can prevent the development of Colon and Rectal Cancer. If a cancer is already present, then the earlier it is detected, the greater the chance is for treatment and cure.